Am J Psychiatry 1994; 151:1753-1759
Copyright © 1994 by American Psychiatric Association
A double-blind dose-reduction trial of fluphenazine decanoate for chronic, unstable schizophrenic patients
LB Inderbitzin, RR Lewine, G Scheller-Gilkey, CD Swofford, GJ Egan, BA Gloersen, BP Vidanagama and C Waternaux
Department of Psychiatry, Grady Memorial Hospital, Atlanta, GA 30335.
OBJECTIVE: This study evaluated the feasibility and impact of gradually
reducing relatively high doses of fluphenazine decanoate by one-half for
chronically impaired, poor inner-city patients with schizophrenia. METHOD:
Forty-three patients currently receiving an average of 23 mg (0.3 mg/kg) of
fluphenazine decanoate every 2 weeks were divided alternately into a group
to remain at current doses (control group) and a group to undergo stepwise
50% dose reduction over 5 months under double-blind conditions. Clinical
status and side effects were assessed quarterly for a year. Relapse was
determined clinically and by changes in psychopathology ratings. RESULTS:
Eighty-six percent (N = 37) of the patients (control group, N = 17;
reduced-dose group, N = 20) completed the study. The groups did not differ
at baseline in demographic or clinical variables or neuroleptic dose. In
the reduced-dose group, doses were lowered to an average of 11.5 mg every 2
weeks. The two groups did not differ throughout the year in number of
relapses, and hospitalization rates fell similarly in both (overall, by
about 67%). Clinical measures changed little. Extrapyramidal symptoms
worsened in the control group but improved slightly in the reduced-dose
group. Tardive dyskinesia worsened in both groups, but less in the reduced-
dose group. CONCLUSIONS: Maintenance neuroleptic doses much lower than the
conventional ones can be achieved safely in schizophrenic patients by
gradual reduction, without clinical worsening and perhaps with fewer
extrapyramidal symptoms and less tardive dyskinesia. The two-thirds lower
hospitalization rate, with substantial financial savings, apparently was
due to nonspecific effects of research intervention.
